[Epidemiological, clinical profile and outcomes of chronic hemodialysis patients in the Nephrology and Hemodialysis Department of the CHU du Point "G"]

AIM

Hemodialysis is the only method of renal replacement in Mali. Purpose of this work: to study the evolution of chronic hemodialysis.

PATIENTS AND METHODS

In a retrospective study, we used the medical charts of 150 patients. The studied parameters were the epidemiology and clinic profile of patients, the risk factors, the quality and the impact of the benefits on the survival. The data were analyzed on SPSS 12.0 for Windows with p <0.05 as the significance value.

RESULTS

The mean age was 40.45 years (15 years and 77 years). Patients have a low income in 60%. The hemoglobin level was less than 9 g/l in 63.3%. Kidney vascular disease was the most frequent causes in 42%. Hyperphosphataemia was found in 38.6%. The lipid balance was disturbed in 73.9%. A central catheter was used directly in 78.7%. The mortality rate was of 37.3%. The death was due to hypertrophic cardiomyopathy in 35.5% (p = 0.002). Low hemoglobin (p = 0.0002), central catheterization (p=0.008), cardiovascular complications (p= 0.007) and hemodialysis duration (p = 0.00001) are the risk factors for high mortality.

CONCLUSION

The duration of life in hemodialysis remains linked to the complications of renal damage and early management.

[Safety and efficacy of peribulbar anesthesia in cataract surgery]

INTRODUCTION

Peribulbar anesthesia (PBA) involves the injection of local anesthetic of volume around the globe and outside the fasciomuscular cone, which will then diffuse from the peribulbar space to the retrobulbar space. The goal was to evaluate the safety and efficacy of PBA in cataract surgery in Secondary Ophthalmology Center.

PATIENTS AND METHOD

this was a cross-sectional study over two months. Our population consisted of all patients admitted to the anesthesia room, scheduled for cataract surgery and the PBA had been completed. The data was analyzed using Epi Info software version 7.2. The correlations were carried out using Khi2 with a threshold of significance (p <0.05).

RESULTS

A total of 285 patients were included and sex-ratio H/F = 0,72. Average age of 62 +/- 12 years. Lidocaïne 2% and Bupivacaine 0.5% was used in combination at equal volume. The anesthesia was tolerated in 99,3% of patients. We observed 77,19% total analgesia and 13,33% chaemosis.

CONCLUSION

Peribulbar anesthesia allows the easy realization of cataract surgery with great safety and efficiency.

[Assessment of quality of life in patients with primary open-angle glaucoma in urban areas]

INTRODUCTION

Quality of life is defined by the physical, emotional and social well-being of an individual. Primary Open Angle Glaucoma (POAG) is a blinding optic neuropathy, it can change the quality of life by its chronic and irreversible nature. The objective of this study was to evaluate the quality of life in patients with POAG in urban areas.

PATIENTS AND METHODS

this was a quantitative cross-sectional study with a descriptive aim over 3 months. Patients followed for POAG at CHU-IOTA with an age ≥ 18 years were included and submitted to the GlauQOL-17 questionnaire for data collection.

RESULTS

We collected 100 glaucomatous patients, the mean age of patients was 52 years with a standard deviation of 14.02. The extreme ages are 18 and 81 years old. There was a male predominance; (54%) with a sex ratio (M / F) of 1.7. The good visual acuities were majority (higher or equal to 3/10). Among our patients, 35% were at the stage of glaucoma starting at OD and 30% at the stage of moderate glaucoma at OG. Our patients had a poor quality of life score (score <50%) in the Anxiety and Driving dimensions. In patients younger than 70 years old, we had a poor anxiety score in all progressive stages of the disease. Scores of self-image dimensions, constraints, and management were greater than 60% in patients over 70 years of age.

CONCLUSION

Alteration of some of the domains studied was proportional to evolution of POAG. This degradation can have physical, psychological and social impacts on his patients.

[Epidemiological study on the visual ability of official public transport drivers in Bamako]

The aim of this work was to evaluate the public transport drivers' visual driving ability in Bamako. We carried out a descriptive cross-sectional study from May 15 to July 15, 2013. The probabilistic method was used. 385 drivers were examined at the University Hospital of the Institute of Tropical Ophthalmology of Africa (IOTA). The average age was 44.69 years. 296 drivers (76.9%) were able to drive public transport vehicles. Among drivers over 50 years old, 42.5% are unfit for driving. Color vision was normal in 98.7 % of cases. Ametropia, cataract and neuropathies accounted for 48.5%, 25.1% and 17.5% respectively, of the causes of impaired vision of drivers. According to European legislation, official transport drivers must be subject to periodic eye examinations. In the absence of such measures in Malian legislation, 42.5% of drivers over 50 years old are unfit to drive. The improvement of road safety requires the renewal and application of the texts for the delivery and renewal of the driver's license of public transport drivers.

Le syndrome des jambes sans repos : fréquence et facteurs de risque chez l’hémodialysé

Le syndrome des jambes sans repos (SJSR) ou syndrome d'impatience musculaire est un trouble moteur caractérisé par des sensations désagréables dans les jambes. Les causes sont mal connues et sa fréquence est estimée entre 25% et 75% chez les hémodialysés. Il s'agit d'une étude transversale monocentrique menée au centre d'hémodialyse du CHU Hassan II de Fès (hôpital Al Ghassani) entre décembre 2012 et janvier 2013. Nous avons défini le syndrome de jambes sans repos selon la définition de l'international restless legs study group de 2003 reposant sur 4 critères essentiels au diagnostic. L'international restless legs syndrome scale (IRLES) a été coté par un même néphrologue pour mesurer la sévérité du syndrome des jambes sans repos. 84 hémodialysés ont répondu au questionnaire avec 41,7% de cas de SJSR dont 6,6% de formes graves. Nous avons retrouvé une association entre le SJSR et la carence martiale p(0,018), la néphropathie initiale p(0,041), l'HTA p(0,026) et le sexe féminin p(0,024). Dans notre série, il ressort que la carence martiale et l'HTA sont les principaux facteurs de risque modifiables de ce syndrome chez nos patients. Les facteurs traditionnels comme le tabagisme, l’âge supérieur à 50 ans et la dialyse inadéquate ne sont pas associés à ce trouble dans notre série.

Course of motor and associative pallidothalamic projections in monkeys

As a result of the frequent performance of lesioning and electrical stimulation procedures targeting the globus pallidus internus (GPi) to treat medically intractable hypokinetic and hyperkinetic movement disorders, the course of the pallidothalamic projections originating, in particular, from the motor territory of GPi has important clinical relevancy. To assess the organization of pallidothalamic projections originating from motor and associative portions of GPi, small quantities of the anterograde/ retrograde tracer, biotinylated dextran amine (BDA) were injected into localized regions of the caudal GPi in squirrel monkeys. The localization to motor and associative territories in GPi was confirmed by examining the corresponding regions of retrograde labeling in the striatum and subthalamic nucleus (STN). The labeled pallidothalamic fibers projected principally medially across the inferior edge of the internal capsule. The fiber bundle ventral to the caudal GPi was mainly devoid of labeling. Fibers labeled along the medial and inferior borders of GPi at centrorostral levels were traceable to the medial edge of the injections. The densest fiber labeling at rostral levels was produced by those injections with the greatest extent of rostral labeling of neurons. In opposition to generally accepted schemes, the findings from this study suggest that the pallidothalamic fibers originating from the caudal portions of GPi, including the motor territory, do not course ventromedially to form the ansa lenticularis, but rather, travel predominately medially through the lenticular fasciculus en route to the thalamus. Thus, proposed surgical schemes to target fibers ventral to the caudal GPi or at the rostral pole of GPi appear to be misguided.

Thalamic inputs to striatal interneurons in monkeys: synaptic organization and co-localization of calcium binding proteins

Recent studies indicate that extrinsic inputs from sensorimotor regions of the cerebral cortex and the centromedian intralaminar thalamic nucleus terminate preferentially upon specific subpopulations of striatal output neurons in monkeys. The objective of the present study was to verify whether this specificity of innervation also characterizes the synaptic interactions between thalamic inputs from the centromedian nucleus and the four major populations of striatal interneurons. This was achieved by double labelling techniques at the electron microscope level, combining the anterograde transport of biotinylated-dextran amine with the immunostaining for specific markers of striatal interneurons (somatostatin, parvalbumin, choline acetyltransferase and calretinin). Injections of biotinylated-dextran amine in the centromedian nucleus led to dense bands of anterograde labelling which, in double immunostained sections, largely overlapped with the four populations of interneurons in the post-commissural region of the putamen. In the electron microscope, biotinylated-dextran amine-containing terminals formed asymmetric axo-dendritic synapses with somatostatin-, parvalbumin-, and choline acetyltransferase-containing elements. However, synapses between anterogradely labelled terminals and calretinin-positive neurons were not found. In sections processed to localize biotinylated-dextran amine and parvalbumin or calretinin, double-labelled terminals (biotinylated-dextran amine/parvalbumin and biotinylated-dextran amine/calretinin), morphologically similar to thalamostriatal boutons, were found in the striatum indicating that calcium binding proteins may be expressed by thalamostriatal neurons. To test this possibility, we combined the retrograde transport of lectin-conjugated horseradish peroxidase from the putamen with parvalbumin and calretinin immunostaining and found that, indeed, most of the retrogradely labelled cells in the centromedian nucleus displayed parvalbumin and calretinin immunoreactivity. Moreover, co-localization studies revealed that calretinin and parvalbumin co-exist in single neurons of the centromedian nucleus. In conclusion, striatal interneurons immunoreactive for somatostatin, parvalbumin and choline acetyltransferase, but not those containing calretinin, receive strong inputs from the centromedian nucleus in monkeys. Moreover, our findings indicate that parvalbumin and calretinin co-exist in individual thalamostriatal neurons. In combination with our previous data, these results suggest that thalamic information may be conveyed to striatal projection neurons both, directly via excitatory synaptic inputs, or indirectly via striatal interneurons. The relative importance of those direct and indirect thalamic influences upon the activity of striatal output neurons remains to be established.

Neuronal circuitry and synaptic connectivity of the basal ganglia

The concept of organization of the basal ganglia has changed markedly over the last 10 years. These developments have led to the introduction of a schematic model of the functional circuitry of the basal ganglia that accounts for normal and abnormal basal ganglia functions. The recent introduction of powerful techniques for the analysis of neuronal networks has led to many new developments in our understanding of the anatomic and synaptic organization of the basal ganglia. The objective of this article is to go from the established model of the basal ganglia connectivity to new anatomic findings that lead to reconsideration and refinement of some aspects of the models.

Efferent connections of the internal globus pallidus in the squirrel monkey: I. Topography and synaptic organization of the pallidothalamic projection

The objectives of this study were, on one hand, to better understand how the segregated functional pathways from the cerebral cortex through the striatopallidal complex emerged in the projections to the thalamus and, on the other hand, to compare the ultrastructure and synaptic organization of the pallidal efferents to the ventrolateral (VL) and centromedian (CM) thalamic nuclei in primates. These aims were achieved by injections of the retrograde-anterograde tracer, biotinylated dextran amine (BDA), in different functional regions of the internal pallidum (GPi) in squirrel monkeys. The location of retrogradely labelled cells in the striatum was determined to ascertain the functional specificity of the injection sites. Injections in the ventrolateral two-thirds of the GPi (group 1) led to retrograde labelling in the postcommissural region of the putamen ("sensorimotor striatum") and plexuses of labelled fibers in the rostral one-third of the principal ventrolateral nucleus (VLp) and the central part of the CM. On the other hand, injections in the dorsal one-third (group 3) and the rostromedial pole (group 4) of the GPi led to retrogradely labelled cells in the body of the caudate nucleus ("associative striatum") and the ventral striatum ("limbic striatum"), respectively. After those injections, dense plexuses of anterogradely labelled varicosities were found in common thalamic nuclei, including the parvocellular ventral anterior nucleus (VApc), the dorsal VL (VLd), and the rostrodorsal part of the parafascicular nucleus (PF). In the caudal two-thirds of the CM/PF, the labelled fibers formed a band that lay along the dorsal border of the complex in a region called the dorsolateral PF (PFdl) in this study. The ventromedial nucleus (VM) was densely labelled only after injections in the rostromedial GPi, whereas the dorsal part of the zona incerta was labelled in both groups. At the electron microscopic level, the BDA-positive terminals in the VLp were larger and more elongated than those in the CM but, overall, displayed the same pattern of synaptic organization. Our findings indicate 1) that some associative and limbic cortical information, which is largely processed in segregated corticostriatopallidal channels, converges to common thalamic nuclei and 2) that the PF is a major target of associative and limbic GPi efferents in monkeys.

Efferent connections of the internal globus pallidus in the squirrel monkey: II. Topography and synaptic organization of pallidal efferents to the pedunculopontine nucleus

The first objective of the present study was to verify whether projections from regions of the internal pallidum (GPi) that receive inputs from different functional areas of the striatum remain segregated at the level of the pedunculopontine nucleus (PPN) in squirrel monkeys. Second, we analyzed the ultrastructural features and synaptic organization of pallidal terminals in contact with PPN neurons. This was achieved by performing iontophoretic injections of biotinylated dextran amine (BDA) in different regions of the GPi. The animals were pooled into three groups on the basis of the location of the injection sites and the resulting distribution of retrogradely labelled striatal neurons. The experimental groups were divided as follows: group 1: injections in the dorsal one-third of the GPi, retrograde labelling in the head and body of the caudate nucleus ("associative striatum"); group 2: injections in the ventrolateral two-thirds of the GPi, retrograde labelling in the postcommissural region of the putamen ("sensorimotor striatum"); and group 3: injections in the rostromedial pole of the GPi, retrograde labelling in the ventral striatum ("limbic striatum"). These injections led to the anterograde labelling of varicose fibers that arborized profusely in common regions of the PPN dorsal to the brachium conjunctivum. The fields of fibers that arose from the dorsal one-third and the rostromedial pole of the GPi were more widely spread than the afferents from the ventrolateral two-thirds of the GPi. Small numbers of retrogradely labelled cells were encountered in the PPN after each injection in the GPi. Some of them were tightly surrounded by large, BDA-containing varicosities, which implies that the connections between the GPi and the PPN are partly reciprocal. In sections processed for the simultaneous localization of beta-nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase (a marker of cholinergic cells in the PPN) and BDA, the anterogradely labelled fibers largely avoided the dense aggregate of NADPH-diaphorase-containing neurons in the PPN pars compacta (PPNc) but, rather, established contacts with unlabelled neurons in the pars dissipata (PPNd). In the electron microscope, the GPi terminals were large (1.0-5.0 microns in diameter), contained many mitochondria and pleomorphic vesicles, and formed symmetric synapses predominantly with proximal dendrites of PPN cells. In conclusion, our data suggest that the noncholinergic neurons of the PPNd are potential targets for the integration of information arising from different functional territories of the GPi in primates. The PPNd is thus in a position to act as an interface between motivational, cognitive, and motor information transmitted along the pallidotegmental projection in primates.

Differential synaptic innervation of striatofugal neurones projecting to the internal or external segments of the globus pallidus by thalamic afferents in the squirrel monkey

It is well established that the centromedian nucleus (CM) is the major source of thalamic afferents to the sensorimotor territory of the striatum in monkeys. However, the projection sites of striatal neurons contacted by thalamic afferents still remain to be determined. We therefore carried out an anatomical study aimed at elucidating the hodology of striatal neurones that receive input from the CM in squirrel monkeys. Our approach was to combine the anterograde transport of Phaseolus vulgaris-leucoagglutinin (PHA-L) or biocytin from the CM with the retrograde transport of biotinylated dextran-amine (bio-dex) or PHA-L from the internal (GPi) or external (GPe) segments of the globus pallidus. Following CM injections, rich plexuses of anterogradely labelled, thin varicose fibres aggregated in the form of bands that were confined to the postcommissural region of the putamen. On the other hand, injections into the GPe or GPi led to profuse retrograde labelling of a multitude of medium-sized spiny neurones. In cases where the injections involved the caudoventral two-thirds of the GPe or GPi, the retrogradely labelled striatopallidal cells and the anterogradely labelled thalamostriatal fibres occurred in the sensorimotor territory of the putamen. After injections into either pallidal segments, clusters of retrogradely labelled cells were in register with bands of anterogradely labelled thalamic fibres. However, electron microscopic analysis of striatal regions containing both anterogradely labelled thalamic afferents and retrogradely labelled cells revealed that terminals from the CM frequently form asymmetric synapses with dendritic shafts and spines of striato-GPi cells but rarely with those of striato-GPe cells. In conclusion, our findings demonstrate that thalamic afferents from the CM innervate preferentially striatopallidal neurones projecting to the GPi in monkeys. These results indicate that the striatopallidal neurones contributing to the "direct" and "indirect" output pathways are differentially innervated by thalamic afferents in primates.

Detection of Actinobacillus pleuropneumoniae in the porcine upper respiratory tract as a complement to serological tests

Attempts were made to isolate Actinobacillus pleuropneumoniae from the nasal cavities and tonsils of 442 healthy pigs from 15 herds. Samples were streaked onto different media formulations. Serum samples were assayed for antibodies to A. pleuropneumoniae by enzyme-linked immunosorbent assay and complement fixation test. Actinobacillus pleuropneumoniae was isolated from the nasal cavities only in 24 pigs, from tonsils only in 90 pigs, and from both the nasal cavities and the tonsils in 11 pigs. A PPLO medium supplemented with lincomycin, bacitracin and crystal violet allowed recovery of A. pleuropneumoniae from more animals than a tryptic soy agar medium from both sites. Incubation of plates in an enriched CO2 atmosphere did not affect the recovery rate. Actinobacillus pleuropneumoniae belonging to serotypes 1, 2, 3, 5a, 5b, 7, 8, 10 and 12 were isolated, and, in several herds, more than one serotype were recovered. Serotypes of A. pleuropneumoniae were isolated from nine herds which were found seronegative to these. The isolation of A. pleuropneumoniae from the upper respiratory tract can be useful for detection of carrier pigs and complements serological screening.

Effects on testosterone, LH and cortisol concentrations, and on testicular ultrasonographic appearance of induced testicular degeneration in bulls

It is well known that heat stress has a detrimental effect on testicular functions. In addition to the alteration of semen quality and testicular damage, reproductive hormone secretion can be altered. The objective of this study was to describe changes in plasma concentrations of testosterone, LH and cortisol, as well as in testicular ultrasonographic appearance after induced testicular degeneration. Four Swedish Red and White bulls, aged 3 years, were used. They were fed according to Swedish standards. The scrotum was covered with an insulation device during 96 h. Semen was collected weekly 3 times before and up to 4 months after insulation. Testicular ultrasonography and clinical genital examination were performed with the same intervals. Heparinized blood samples were taken from the jugular vein at 2 h interval during 24 h every 2 weeks during the study. Blood samples were tested for the content of testosterone, LH and cortisol. Data were analysed, using one way analysis of variance of seminal data, clinical examination data as well as 24 h hormonal output data as percentage of mean individual pretreatment values. The use of a 5 MHz B-mode ultrasound unit did not contribute with an objective estimation of the degree of testicular degeneration. In 3 of the bulls testosterone levels had a tendency to decrease and LH to increase during the time of severe degeneration, whereas an opposite trend was seen during the regenerative phase, changes becoming significant 15 weeks after scrotal insulation. Variation between animals was big. Cortisol levels had a decreasing trend, changes being significant only in individual bulls at 10 and 15 weeks after scrotal insulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects on testosterone, LH and cortisol concentrations, and on testicular ultrasonographic appearance of induced testicular degeneration in bulls

It is well known that heat stress has a detrimental effect on testicular functions. In addition to the alteration of semen quality and testicular damage, reproductive hormone secretion can be altered. The objective of this study was to describe changes in plasma concentrations of testosterone, LH and cortisol, as well as in testicular ultrasonographic appearance after induced testicular degeneration. Four Swedish Red and White bulls, aged 3 years, were used. They were fed according to Swedish standards. The scrotum was covered with an insulation device during 96 h. Semen was collected weekly 3 times before and up to 4 months after insulation. Testicular ultrasonography and clinical genital examination were performed with the same intervals. Heparinized blood samples were taken from the jugular vein at 2 h interval during 24 h every 2 weeks during the study. Blood samples were tested for the content of testosterone, LH and cortisol. Data were analysed, using one way analysis of variance of seminal data, clinical examination data as well as 24 h hormonal output data as percentage of mean individual pretreatment values. The use of a 5 MHz B-mode ultrasound unit did not contribute with an objective estimation of the degree of testicular degeneration. In 3 of the bulls testosterone levels had a tendency to decrease and LH to increase during the time of severe degeneration, whereas an opposite trend was seen during the regenerative phase, changes becoming significant 15 weeks after scrotal insulation. Variation between animals was big. Cortisol levels had a decreasing trend, changes being significant only in individual bulls at 10 and 15 weeks after scrotal insulation.(ABSTRACT TRUNCATED AT 250 WORDS)